Credit and Collections Analyst
BH Properties
Manager, Provider Contracting - Ancillary/Hospital/Physician Group
The Cigna Group
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $91,200 - $152,000 per year
Job Level
Mid-LevelSenior
About the role
- Manages complex contracting and negotiations for fee for service, capitation, and other value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups)
- Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy
- Initiates and maintains effective channels of communication with matrix partners including Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service
- Contributes to the development of alternative network initiatives
- Supports and provides direction to develop network analytics required for the network solution
- Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position
- Creates and manages initiatives that improve total medical cost and quality
- Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives
- Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms
- Creates healthcare provider agreements that meet internal operational standards and external provider expectations and ensures accurate implementation and administration through matrix partners
- Assists in resolving elevated and complex provider service complaints and researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues
- Manages key provider relationships and is accountable for critical interface with providers and business staff
- Demonstrates knowledge of providers in an assigned geographic area and the competitive landscape
- Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance
- May provide guidance or expertise to less experienced specialists
- Reports to VP, Network Management and supports the Walnut Creek, CA market
Requirements
- Will support the Walnut Creek, CA market; person will need to live in the local area: Walnut Creek, Oakland, Berkeley, San Ramon, Concord, Pleasant Hill, CA areas are preferred
- Should possess a bachelor’s degree; preferably in the areas of Finance, Economics, Healthcare or Business related
- Significant industry experience will be considered in lieu of a bachelor’s degree
- MBA or MHA preferred
- 3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required
- Experience in developing and managing key provider relationships
- Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred
- Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
- Intimate understanding and experience with hospital, managed care, and provider business models
- Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
- Ability to influence both sales and provider audiences through strong written and verbal communication skills
- Experience with formal presentations
- Customer centric and interpersonal skills
- Demonstrates an ability to maneuver effectively in a changing environment
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- Knowledge and use of Microsoft Office tools
- If working at home occasionally or permanently, internet connection must be cable broadband or fiber optic with at least 10Mbps download/5Mbps upload
